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"Albany Horseworld"
Albany Equestrian Centre Eventing Grand Prix
Sunday, 14 July 2019
Entry Form
(Separate Entry for Each Horse)
(Closing Date:
8 July 2019)
Class
Please Select
Class 1 - 105cm Open
Class 2 - 95cm Open
Class 3 - 80cm Open
Class 4 - 80cm Junior
Class 5 - 65cm Open
Class 6 - 65cm Junior
Class 7 - 45cm Open
Class 8 - 45cm Junior
Rider Details
Rider Name
Address
Suburb/City
PostCode
Mobile Phone
Email
Rider Club
Please Select
Non-Member
A.H.A.
A.P.C.
A.A.R.C.
A.N.T.s
S.D.D.C.
Friends of the A.E.C.
Rider Age Category:
Please Select
Junior
Senior
Horse/Pony Details
Horse Name
Owner (if not Rider)
Stallion:
Enter Y(Yes) or Leave Blank
Emergency Contact at Event:
Name
Mobile Phone
Helper Duties
Helper Name
First Preference
Please Select
No particular preference
Payment of Helper Fee
Special Request
Cross Country Jump Judge
Finish - Timing
Marshall
Showjumping - Rails
Showjumping - Judge
Showjumping - Penciller
Showjumping - Set Up (Fri, 24 May @ 1.00pm)
Showjumping - Take Down (after event)
Second Preference
Please Select
Nil
No particular preference
Payment of Helper Fee
Special Request
Jump Judge
Finish Timing
Marshall
Showjumping - Rails
Showjumping - Judge
Showjumping - Penciller
Showjumping - Set Up (Fri, 24 May @ 1.00pm)
Showjumping - Take Down (after event)
Helper Experience
Please Select
N/A
Very Experienced
Some Experience
No Experience
Helper Age
Please Select
N/A
15-20 years
20-30 years
Over 30-years
Helper Duty - Special Request
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Fees
Entry Fees
Camping Fees ($5.00/Night)
Number of Nights
Camping Fee
Late Entry Fee ($15)
Helper Fee ($25 if no helper duty indicated)
Total Fees:
Your Entry will not be accepted without payment of the above fee
Direct Transfer
Account Name
Albany Equestrian Centre Inc
BSB
633-000
Account Number
143217743
Payment Receipt Details
Date
Amount
Receipt Number
Dangerous Activity Acknowledgement
Horse Sports are a Dangerous Activity
I understand and acknowledge that horse sports are a dangerous activity and
that horses can act in a sudden and unpredictable way, especially if
frightened or hurt.
I understand and acknowledge that serious INJURY or DEATH may result from
horse
sport
activities and in particular from events in which I participate.
I agree that I PARTICIPATE at my OWN RISK.
Effect of this Document
I understand that submission of this Entry Form constitutes
a complete and
unconditional release of the Equestrian Federation of
Australia Ltd including all of its state bodies, coaches and Albany Equestrian
Centre Inc, to the greatest extent allowed by law
in the event of me and/or
the children under my care, suffering injury or death.
By submitting this Entry Form,
I ACCEPT I confirm having
read and understood the
contents of this disclaimer.
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